Cost-effectiveness analysis is a mandatory strategy for health systems: evidence from a study involving therapies for hepatitis C

• Main Authors: João Paulo Vilela Rodrigues, Maurílio de Souza Cazarim, Silvana Gama Florencio Chachá, Ana de Lourdes Candolo Martinelli, Leonardo Régis Leira Pereira
• Format: Article
• Language: English
• Published: Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz
• Series: Cadernos de Saúde Pública
• Subjects: economía; preparaciones farmacéuticas; toma de decisiones; hepatitis c; inhibidores de proteasas
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2020000205006&lng=en&tlng=en
• ISSN: 0102-311X; 1678-4464

Abstract: Cost-effectiveness analysis is essential in health decision making. Several countries use it as synthesis of evidence to incorporate health technologies. The protease inhibitors (PI) boceprevir (BOC) and telaprevir (TVR) are indicated for chronic hepatitis C treatment and were incorporated in guidelines worldwide. Pre-marketing clinical trials showed higher sustained virological response rates in relation to previous therapies, but the incorporation of PIs generated a significant financial impact. The aim of this study was to discuss the relevance of cost-effectiveness analysis through a study that involved the inclusion of PIs in a clinical protocol. The analysis was part of a real-life study that included patients infected with hepatitis C virus genotype 1 treated in a tertiary university hospital in Brazil. Triple therapies (TT) with ribavirin (RBV), peginterferon α-2a (Peg-INF α-2a) and BOC or TVR were compared to dual therapy with RBV and Peg-INF α-2a. Sensitivity analysis of the cost-effectiveness ratio indicated an 88.2% chance of TTs presenting a higher cost per cure. The incremental cost-effectiveness ratios (ICER) exceeded the Brazilian gross domestic product (GDP) per capita by three times in all proposed scenarios. The sensitivity of ICER showed an 88.4% chance of TT not being cost-effective. The impact of PI incorporation was negative and the conduct about this could have been different if a previous cost-effectiveness analysis had been conducted.